Supporting parents for a healthy equitable future
Authors: None The Lancet Public Health
Journal: The Lancet Public Health (2023)

Often the most memorable times in one's life, pregnancy, birth, and early parenthood can also be associated with unprecedented stress and challenges. According to WHO, one in five women could experience a mental health condition during pregnancy or within 1 year of giving birth. This perinatal period is sensitive to traditional risk factors (such as alcohol and tobacco), but also to socioeconomic and political determinants of health. This issue of The Lancet Public Health sheds light on some of these public health issues. Alcohol consumption in pregnancy remains an important public health concern. Marcella Broccia and colleagues used data from Danish nationwide registries to document the consequences of heavy prenatal alcohol exposure. In their first Article, Broccia and colleagues report that heavy prenatal alcohol exposure is associated with adverse obstetric and birth outcomes, including small for gestational age, preterm birth, and haemorrhage in late pregnancy. In their second Article, they report an association between increased risk of child morbidities with heavy prenatal alcohol exposure and document previously unidentified issues, such as conditions associated with brain function, infections, and injuries but also child maltreatment. In their linked comment, Sonya Scott and Jonathan Sher urge the need for individual support along with system and structural changes to prevent alcohol-related harm. Perinatal mental health is increasingly seen as critical to public mental health, but there is still widespread stigma around perinatal mental health and limited strategies to support and improve parents’ perinatal mental health and wellbeing. Parental paid leave policies can support parents and offer financial stability, flexibility, and time to bond with their baby. In their Systematic Review, Amy Heshmati and colleagues look at the effect of parental leave on parents’ mental health and report that paid leave, especially that of at least 2–3 months, is associated with reduced risk of poor maternal mental health but there was no strong evidence regarding the effects of parental leave use on partners’ mental health. Katharine Barry and colleagues looked specifically at the potential effect of paternity leave on parental post-partum depression in a French cohort. They report that fathers who took or intended to take even a short paid paternity leave (2-weeks) had lower odds of depression at 2 months after their child's birth, however, they reported an increase in mothers’ post-partum depression when their partners took paternity leave—raising questions regarding optimal timing and duration. These two reports add to a growing body of evidence suggesting that paid leave policies can support mental health among new parents, but also highlight the importance of policy design in realising these benefits, noted Julia Goodman and Lisset Dumet Poma in their Comment. An equity lens and an intersectional approach are needed to fully understand access to paid leave and its mental health benefits. According to the 2022 International Labour Organization's report Care at Work: Investing in Care Leave and Services for a More Gender Equal World of Work, “maternity leave is a universal human and labour right, and yet it remains unfulfilled” with 649 million women having inadequate maternity protection; while paternity leave remains an afterthought, with almost two-thirds of potential fathers (1·26 billion men) living in countries with no entitlements to paternity leave. When paternity leave is available, it is short, with a global average of 9 days, and is low paid with only three in ten fathers being paid 100% of their previous earnings. Self-employed, workers in the informal economy, migrants, adoptive, and LGBTQI+ parents are frequently excluded from leave provisions. Worryingly, 132 countries do not offer a right to paid time off for prenatal medical examinations, despite the importance of antenatal care in the prevention and management of obstetric complications, maternal mortality, and inequalities in maternal and child health outcomes. Addressing reproductive health needs across the lifecourse requires an integrated, community-based approach combining contraception and preconception care as proposed by Jennifer Hall and colleagues. To address the wider determinants of health during the perinatal period, major gaps in availability, access, adequacy, and quality of parental leave policies and care services need much more attention, efforts, and bold political will. Governments, policy makers, and employers need to support and invest in equitable access to parental leave policies and perinatal health care to reduce gender inequalities at home, work, and in society. For the ILO's Care at work report see https://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/documents/publication/wcms_838653.pdf For the ILO's Care at work report see https://www.ilo.org/wcmsp5/groups/public/---dgreports/---dcomm/documents/publication/wcms_838653.pdf Paid parental leave and mental health: the importance of equitable policy designIn The Lancet Public Health, Katharine M Barry and colleagues1 and Amy Heshmati and colleagues2 focus on the important association between paid leave uptake and mental health among new parents. In their systematic review, Heshmati and colleagues2 report that parental leave could be protective against poor mental health for mothers in the post-partum period, especially paid leave of at least 2–3 months. They found some evidence that fathers’ mental health improved in the presence of policies that provided adequate wage replacement or other incentives to take leave, but did not find strong evidence for indirect effects of parental leave use on partners’ mental health. Full-Text PDF Open AccessEffect of alcohol during pregnancy: a public health issueAlcohol is a known teratogen and associated with a range of adverse outcomes for pregnant women and children exposed in utero.1–3 The most prominent of these is known as fetal alcohol spectrum disorder.4 The Danish Health Authority, as well as the UK Chief Medical Officers, recommend women abstain from alcohol during pregnancy or when trying to conceive.5,6 Full-Text PDF Open AccessPaternity leave uptake and parental post-partum depression: findings from the ELFE cohort studyTaking and intending to take 2-weeks’ paid paternity leave was associated with a reduced likelihood of reporting post-partum depression in fathers. However, offering 2-weeks’ paternity leave might place mothers at a greater risk of post-partum depression, suggesting that optimal length and timing of the leave, among other factors, need further investigation. Full-Text PDF Open AccessHeavy prenatal alcohol exposure and obstetric and birth outcomes: a Danish nationwide cohort study from 1996 to 2018Heavy prenatal alcohol exposure is associated with adverse obstetric and birth outcomes and high proportions of maternal low educational level, psychiatric disease, and lifestyle risk behaviours. These findings highlight a need for holistic public health programmes and policy attention on improving pre-conceptional care and antenatal care. Full-Text PDF Open AccessHeavy prenatal alcohol exposure and overall morbidities: a Danish nationwide cohort study from 1996 to 2018Heavy prenatal alcohol exposure is associated with an overall increased risk of child morbidities and previously unrecognised alcohol-related health problems. Prenatal alcohol exposure is a key public health issue with a potential negative impact on child and adolescent health. This study urges for renewed efforts and substantiates the profound degree to which pre-conceptional care is mandatory. Full-Text PDF Open AccessThe effect of parental leave on parents’ mental health: a systematic reviewMental health disorders during the post-partum period are a common morbidity, but parental leave might help alleviate symptoms by preventing or reducing stress. We aim to summarise available evidence on the effect of different types of parental leave on mental health outcomes among parents. For this systematic review, we searched Ovid MEDLINE, Web of Science, PsycINFO, CINAHL, and Scopus from database inception to Aug 29, 2022, for peer-reviewed, quantitative studies written in English. We included studies if the exposure was postnatal parental leave; a relevant comparison group was present (eg, paid vs unpaid leave); and if indicators related to general mental health, including depression, anxiety, stress, and suicide, for either parent were evaluated or recorded at any time after childbirth. Full-Text PDF Open AccessAddressing reproductive health needs across the life course: an integrated, community-based model combining contraception and preconception carePrevention of pregnancy (contraception) and preparation for pregnancy (preconception care) are services that most people need during their reproductive life course. Despite increased attention, and growing recognition that health before pregnancy is crucial to addressing disparities in maternity outcomes, service provision is far from routine. We bring together evidence from the literature, new quantitative and qualitative data on women's preferences, and case studies of existing practice, to develop an integrated, community-based model that synthesises reproductive life planning, contraception, and preconception care. Full-Text PDF Open Access